Who can afford a Mirena® for contraception?

Abstract

INTRODUCTION: The Mirena®, a levonorgestrel-releasing intrauterine system (LNG-IUS), is an effective form of contraception that lasts for 5 years. In New Zealand, it is not subsidised for contraception and the device costs NZ$340 at Family Planning clinics. AIM: To determine if there is a difference in the socioeconomic status and ethnicity of women who chose an LNG-IUS for contraception compared with women opting for a subsidised long-acting contraceptive (copper intrauterine device (IUD) or Jadelle® implant) or who qualified for a Special Authority Mirena® (funded by Pharmac, as treatment for heavy menstrual bleeding). METHODS: All the Mirena®, Jaydess®, IUD and Jadelle® insertions that occurred at Family Planning clinics in 2015 in the Wellington region were identified. The deprivation quintile of current address and ethnicity were determined. RESULTS: In the study period, 1410 devices were inserted. Of the self-funded LNG-IUSs inserted, 5% were for women with quintile 5 addresses (areas with the most deprived New Zealand Deprivation (NZDep) scores) and 28% for quintile 1 areas (least deprived NZDep scores). Of the Special Authority Mirenas® inserted, 24% were for women residing in quintile 5 areas and 19%, quintile 1 areas. Self-funded LNG-IUS were chosen by 2.5% of Māori women choosing contraception at study Family Planning clinics and no Pacific Peoples, whereas 21% of New Zealand European women chose LNG-IUS. Special Authority Mirenas® were chosen by 9.5% Māori and 9.6% Pacific Peoples compared to 4% New Zealand Europeans. DISCUSSION: Māori, Pacific Peoples and women residing in quintile 5 areas chose self-funded LNG-IUSs less often than Special Authority Mirenas®. This was not the case for the other groups, who showed higher use of self-funded LNG-IUSs than Special Authority Mirenas®.